Volume 10, Number 3—March 2004
Dispatch
Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands
Peter G.M. Mol*†
, Willem J.M.J. Rutten†, Rijk O.B. Gans†, John E. Degener†, and Flora M. Haaijer-Ruskamp*
, Willem J.M.J. Rutten†, Rijk O.B. Gans†, John E. Degener†, and Flora M. Haaijer-Ruskamp*
Table 1
Quotations illustrating themes
| Level of | Quotation | |
|---|---|---|
| Guideline characteristics |
“It would be great to have an electronic version” or “…even better everyone a handheld PDA with guideline.” [R1]a
“You have to go with the flow and not necessarily against it…otherwise you will have a hard time |getting the guideline accepted|.b” [S1] |
|
| Physicians’ characteristics |
“I often look in the booklet |guideline| especially for those indications that you do not encounter much…” [R4]
“…you sometimes get these incomplete results: just a gram-stain without sensitivity results, I then rather wait for the complete results” [R5]
“…they |residents| do not look at the quality of the |culture and sensitivity| tests” [ID]
“I would continue. |with broad-spectrum therapy even when a cultured pathogen is sensitive to a more narrow spectrum agent| The patient is doing well, he is responding to his antibiotic therapy. I would not streamline at this time. I do not see any reason. ...Never change a winning team.” [R1]
“My autonomy… as a lung specialist I feel I have and can decide on |what treatment for| pulmonary infections” [S2]
“…for the large majority of patients it |choice of antibiotic| is just very clear, it is just a formality.” [S3]
“In our department? I cannot remember the time we had resistant pneumococci. We know they exist and we remind each other of that, but we have never had that here.” [S2]
“..horrible..I can imagine obliging people to use it |registration form| in the framework of their training… but to have to defend this as a standard measure, I do think this goes too far.” [S5]
“A wonderful idea… it could be quite a guiding instrument ... it should be education and intervention.” [ID] |
|
| Social and institutional context | “…and when you move to another department you learn within a week their |supervising specialists| prescribing preferences… they will just keep an eye on you.” [R4] “I would first consult my supervisor and if he gets stuck I would ring up a microbiologist.” [R5] | |
aR, resident; S, supervisor; ID, infectious disease specialist.
b|Text| is added by the author for clarification. This additional text is merely meant to clarify a physician’s statement, and we have made every effort to not altering the implication of any statement
1A paper “critical-pathway” combines an antimicrobial drug order form with a decision support tool. Filling out a few relevant case-characteristics guides the prescriber to the guideline’s recommendation for that specific case.
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